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Older Hepatitis C Patients Have More Side Effects from Interferon-based Therapy, but Many Can Achieve Sustained Response

Chronic hepatitis C patients age 65 or older may experience more adverse events and have a higher rate of treatment discontinuation than late middle-aged people when using pegylated interferon plus ribavirin, according to a study from Taiwan published in the March 1, 2010 Journal of Infectious Diseases. Nevertheless, half of older patients with HCV genotype 1 and nearly 80% of those with genotypes 2 or 3 achieved sustained virological response.

In the U.S. the prevalence of advanced liver disease related to hepatitis C virus (HCV) infection is increasing as people infected years or decades ago reach the stage where they develop cirrhosis, liver cancer, and other complications. Some past research indicates that older individuals do not respond as well to interferon-based therapy, but data are inconsistent.

In the present study, Chung-Feng Huang from Kaohsiung Medical University in Taiwan and colleagues evaluated the safety and efficacy of pegylated interferon alpha-2a (Pegasys) plus ribavirin in 70 older hepatitis C patients (65 years or more) compared with 140 late middle-aged patients (50-64 years) matched according to sex and HCV genotype.

Results

• The older group had a significantly higher rate of treatment discontinuation compared with the middle-aged group (21.4% vs 6.4%, respectively; P = 0.001).
• Severe (grade 3 or 4) adverse events were also more common in the older patients (34.3% vs 20.0%, respectively, P = 0.002).
• In intent-to-treat analysis, the sustained virological response (SVR) rate was "substantially lower" for the older compared with the middle-aged group (67.1% vs 78.6%, respectively), but the difference did not reach statistical significance (P = 0.07).
• The SVR rate was significantly lower for older versus middle-aged patients with HCV genotype 1 (51.9% vs 75.9%, respectively; P = 0.03).
• However, sustained response rates for older and middle-aged participants with genotypes 2 or 3 were statistically similar (76.7% vs 80.2%; P = 0.65).
• Among older patients who experienced a rapid virological response at week 4 of treatment, those with genotype 1 and those with genotypes 2 or 3 had similar SVR rates (80.0% vs 87.9%, respectively).
• Among participants who received treatment for > 80% of the original expected duration, SVR rates were similar in the older and middle-aged groups regardless of genotype (80.4% vs 82.6%, respectively).

Based on these findings, the study authors concluded, "Older patients with HCV infection, especially those in the subgroup infected with HCV [genotype] 1, had a greater frequency of adverse events and poorer adherence to the standard-of-care regimen, which may be the major reason for treatment inferiority."

The SVR rates seen in this study -- even for the older genotype 1 patients, but more so for the middle-aged group -- were on the high end of response rates usually seen in U.S. and European studies. Research indicates, however, that Asian patients typically respond better to interferon-based therapy than whites, who in turn respond better than blacks.

Hepatobiliary Division, Department of Internal Medicine and Departments of Occupational Medicine and Preventive Medicine, Kaohsiung Medical University Hospital, Graduate Institute of Medicine and Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, and Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.

3/30/10

Reference

CF Huang, JF Yang, CY Dai, and others. Efficacy and Safety of Pegylated Interferon Combined with Ribavirin for the Treatment of Older Patients with Chronic Hepatitis C. Journal of Infectious Diseases 201(5): 751-759. March 1, 2010.